MedPath

Rituximab Plus Lenalidomide for Patients With Relapsed / Refractory Indolent Non-Hodgkin's Lymphoma (Follicular Lymphoma and Marginal Zone Lymphoma)

Phase 3
Completed
Conditions
Lymphoma, Non-Hodgkin
Interventions
Registration Number
NCT01938001
Lead Sponsor
Celgene
Brief Summary

This double-blind randomized, parallel group study will evaluate the efficacy and safety of lenalidomide (Revlimid, CC-5013) in combination with rituximab (MabThera/Rituxan) in patients with relapsed or refractory follicular lymphoma or marginal zone lymphoma. Patients will be randomized to receive either lenalidomide or placebo for twelve 28-day cycles in combination with rituximab. Anticipated time on study treatment is 1 year.

Detailed Description

Indolent lymphoma is a slow growing but incurable lymphoma which includes follicular lymphoma and marginal zone lymphoma. Follicular lymphoma and marginal zone lymphoma are cancers of the B lymphocyte, a type of white blood cell. Lenalidomide is an immunomodulatory drug (a drug that affects the immune system) which alters the body's immune system and it may also interfere with the development of tiny blood vessels involved in tumor growth. Therefore, lenalidomide may reduce or prevent the growth of cancer cells. Lenalidomide has also been shown to restore the immune cells' ability to attack and kill tumor cells, an ability that may be inhibited by follicular lymphoma and other lymphomas. The combination of rituximab and lenalidomide may eliminate the cancer while restoring the immune system's ability to attack tumor cells.

Recruitment & Eligibility

Status
COMPLETED
Sex
All
Target Recruitment
358
Inclusion Criteria
  • Age ≥18 years at the time of signing the informed consent document.
  • Understand and voluntarily sign an informed consent document prior to any study related assessments/procedures are conducted.
  • Histologically confirmed marginal zone lymphoma or follicular lymphoma (grade 1, 2 or 3a; CD20+ by flow cytometry or histochemistry).
  • Previously treated with at least one prior systemic chemotherapy, immunotherapy or chemoimmunotherapy and have received at least 2 previous doses of rituximab.
  • Documented relapsed, refractory or progressive disease after treatment with systemic therapy and must not be rituximab-refractory.
  • Investigator considers rituximab monotherapy appropriate.
  • Bi-dimensionally measurable disease on cross sectional imaging by X-ray computed tomography (CT) or magnetic resonance imaging (MRI).
  • Need of treatment for relapsed, progressed or refractory disease as assessed by the investigator.
  • Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2.
  • Adequate bone marrow function.
  • Willingness to follow study visit schedule, pregnancy precautions and other protocol requirements.
Exclusion Criteria
  • Histology other than follicular or marginal zone lymphoma or clinical evidence of transformation or Grade 3b follicular lymphoma.
  • Subjects taking corticosteroids during the last week prior to study treatment, unless administered at a dose equivalent to < 20 mg/day prednisone or prednisolone.
  • Systemic anti-lymphoma therapy within 28 days or use of antibody agents within 8 weeks use of radioimmunotherapy within 6 months.
  • Known seropositive for or active viral infection with hepatitis B virus (HBV) or/and human immunodeficiency virus (HIV).
  • Known hepatitis C virus (HCV) positive with chronic HCV or active viral infection with HCV hepatitis requiring anti-viral medication (at time of randomization).
  • Life expectancy < 6 months.
  • Known sensitivity or allergy to murine products.
  • Prior history of malignancies, other than follicular or marginal zone lymphoma, unless the subject has been free of the disease for ≥ 5 years.
  • Prior use of lenalidomide.
  • Known allergy to thalidomide.
  • Neuropathy > Grade 1.
  • Presence or history of central nervous system involvement by lymphoma.
  • Subjects who are at a risk for a thromboembolic event and are not willing to take prophylaxis for it.
  • Uncontrolled intercurrent illness.
  • Any significant medical condition, laboratory abnormality, or psychiatric illness that would prevent the subject from signing the informed consent document.
  • Pregnant or lactating females.
  • Any condition that places the subject at unacceptable risk if he/she were to participate in the study or that confounds the ability to interpret data from the study.

Study & Design

Study Type
INTERVENTIONAL
Study Design
PARALLEL
Arm && Interventions
GroupInterventionDescription
Rituximab and PlaceboPlaceboParticipants received riituximab 375 mg/m\^2 IV every week in Cycle 1 (Days 1, 8, 15 and 22) and on Day 1 of every 28-day cycle from cycle 2 to 5 plus placebo (identically matched capsule) once daily on Days 1 to 21 of every 28-day cycle up, to 12 cycles.
Rituximab and LenalidomideRituximabParticipants received rituximab 375 mg/m\^2 intravenously (IV) every week in Cycle 1 (Days 1, 8, 15 and 22) and on Day 1 of every 28-day cycle from Cycles 2 to 5 plus lenalidomide 20 mg by mouth (PO) once daily on Days 1 to 21 every 28 days, up to 12 cycles (21-day treatment and 7-day rest period); if creatinine clearance (CrCl) was ≥ 30 mL/min but \< 60 mL/min, participants received lenalidomide 10 mg capsules on days 1 to 21 every 28 days.
Rituximab and PlaceboRituximabParticipants received riituximab 375 mg/m\^2 IV every week in Cycle 1 (Days 1, 8, 15 and 22) and on Day 1 of every 28-day cycle from cycle 2 to 5 plus placebo (identically matched capsule) once daily on Days 1 to 21 of every 28-day cycle up, to 12 cycles.
Rituximab and LenalidomideLenalidomideParticipants received rituximab 375 mg/m\^2 intravenously (IV) every week in Cycle 1 (Days 1, 8, 15 and 22) and on Day 1 of every 28-day cycle from Cycles 2 to 5 plus lenalidomide 20 mg by mouth (PO) once daily on Days 1 to 21 every 28 days, up to 12 cycles (21-day treatment and 7-day rest period); if creatinine clearance (CrCl) was ≥ 30 mL/min but \< 60 mL/min, participants received lenalidomide 10 mg capsules on days 1 to 21 every 28 days.
Primary Outcome Measures
NameTimeMethod
Kaplan Meier Estimate of Progression Free Survival Assessed by the Independent Review Committee (IRC) According to the 2007 International Working Group Response Criteria (IWGRC)From randomization of study drug up to disease progression or death, which occurred first; up to the data cut-off date of 22 June 2018; overall median follow-up time for all participants was 28.30 months (range: 0.1 to 51.3 months).

Progression-free survival (PFS) was defined as the time from date of randomization into the study to the first observation of documented disease progression or death due to any cause, whichever occurred first. PFS was based on the data from the IRC review using the modified 2007 International Working Group Response Criteria (IWGRC) using FDA censoring rules.

Secondary Outcome Measures
NameTimeMethod
Percentage of Participants With an Objective Response as Assessed by the IRC According to the 2007 IWGRCFrom date of first dose to data cut-off date of 22 June 2018; the median treatment duration was 11.19 months in the rituximab/lenalidomide arm and 11.04 months in the rituximab/placebo arm

Percentage of participants with an objective response is defined as having a response of at least a PR during the study without administration of new anti-lymphoma therapy. A complete response = a complete disappearance of all detectable clinical and radiographic evidence of disease, disappearance of any disease-related symptoms, and normalization of biochemical abnormalities; a partial response (PR) = 50% decrease in SPD of the 6 largest dominant nodes or nodal masses. No increase in the size of other nodes, liver, or spleen. Splenic and hepatic nodules must regress by at least 50% in the SPD.

Durable Complete Response Rate (DCCR) as Assessed by the IRC According to the 2007 IWGRCFrom first dose of investigational product (IP) to data cut-off date of 22 June 2018; the median treatment duration was 11.19 months in the rituximab/lenalidomiade arm and 11.04 months in the rituximab/placebo arm

DCCR was defined as the percentage of participants with a best response of complete response (CR) that lasted no less than one year (≥ 48 weeks) during the study prior to administration of new anti-lymphoma therapy. A CR is defined as a complete disappearance of any disease-related symptoms and normalization of biochemical abnormalities.

Percentage of Participants With a Best Response of Complete Response as Assessed by the IRC According to the 2007 IWGRCFrom date of first dose up to data cut-off date of 22 June 2018; the median treatment duration was 11.19 months in the rituximab/lenalidomide arm and 11.04 months in the rituximab/placebo arm

Percentage of participants with a best response of at CR during the study without administration of new anti-lymphoma therapy. A CR = Complete disappearance of all detectable clinical and radiographic evidence of disease, disappearance of any disease-related symptoms, and normalization of biochemical abnormalities.

Kaplan-Meier Estimate of Duration of Complete Response (DOCR) as Assessed by the IRC According to the 2007 IWGRCFrom randomization up to data cut-off date of 22 June 2018; overall median follow-up time for all participants was 28.30 months (range: 0.1 to 51.3 months).

DOCR was defined as the time from initial CR until documented PD or death. Participants who had not progressed at the time of analysis were censored at the last assessment date that the participant was known to be progression free. Participants who received a new treatment without documented progression were censored at the last assessment date that the participants was known to be progression free.

Kaplan-Meier Estimate of Overall Survival (OS)From date of randomization to death due to any cause (Average of 55.71 months and a maximum up to 95.2 months)

Overall survival was defined as the time from randomization to death from any cause. Overall survival was censored at the last date that the participant was known to be alive for participants who were alive at the time of analysis and for participants who were lost to follow-up before death was documented.

Kaplan-Meier Estimate of Duration of Objective Response as Assessed by the IRC According to the 2007 IWGRCFrom randomization up to data cut-off date of 22 June 2018; overall median follow-up time for all participants was 28.30 months (range: 0.1 to 51.3 months).

Duration of response (DOR) was defined as the time from initial response (at least PR) until documented progressive disease (PD) or death. Participants who had not progressed at the time of analysis were censored at the last assessment date that the participant was known to be progression free. Participants who received a new treatment without documented progression were censored at the last assessment date that the participants was known to be progression free.

Kaplan Meier Estimate of Event Free Survival as Assessed by the IRC According to the 2007 IWGRCFrom date of randomization to data cut-off date of 22 June 2018; overall median follow-up time for all participants was 28.30 months (range: 0.1 to 51.3 months).

Event-free survival (EFS) was defined as the time from date of randomization to date of first documented progression, relapse, institution of new anti-lymphoma treatment (chemotherapy, radiotherapy or immunotherapy) or death from any cause. Responding participants and those who were lost to follow up were censored at their last tumor assessment date.

Kaplan Meier Estimate of Time to Next Anti-Lymphoma Treatment (TTNLT)From date of randomization to date of first documented administration of a new anti-lymphoma treatment (Average of 55.71 months and a maximum up to 95.2 months)

Time to next anti-lymphoma treatment (TTNLT) was defined as the time from date of randomization to date of first documented administration of a new anti-lymphoma treatment (including chemotherapy, radiotherapy, radioimmunotherapy or immunotherapy). The time to the next anti-lymphoma treatment was of special interest to the study.

Number of Participants With Treatment Emergent Adverse Events (TEAEs)From first dose to 28 days post last dose (Average of 55.71 months and a maximum up to 95.2 months)

TEAEs include AEs that started or worsened between the date of the first dose and 28 days after the date of the last dose. A serious adverse event (SAE) is any: • Death; • Life-threatening event; • Any inpatient hospitalization or prolongation of existing hospitalization; • Persistent or significant disability or incapacity; • Congenital anomaly or birth defect; • Any other important medical event. The investigator determined the relationship of an AE to study drug based on the timing of the AE relative to drug administration and whether or not other drugs, therapeutic interventions, or underlying conditions could provide a sufficient explanation for the event. The severity of an AE was evaluated by the investigator according to National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) (Version 4.03) where Grade 1 = Mild, Grade 2 = Moderate, Grade 3 = Severe, Grade 4 = Life-threatening and Grade 5 = Death

Trial Locations

Locations (160)

SUNY Upstate Medical University

🇺🇸

Syracuse, New York, United States

Arlington Cancer Center

🇺🇸

Arlington, Texas, United States

Beijing Cancer Hospital

🇨🇳

Beijing, PR, China

Xijing Hospital

🇨🇳

Xi'an, China

Fundação Antonio Prudente - AC Camargo Câncer center

🇧🇷

São Paulo, Brazil

CH Perpignan - Hopital Saint-Jean

🇫🇷

Perpignan, France

Centre Hospitalier de Valence

🇫🇷

Valence, France

Local Institution - 371

🇧🇪

Gent, Belgium

Fujian Medical University Union Hospital

🇨🇳

Fuzhou, China

Local Institution - 604

🇨🇳

Hangzhou City, China

Northwest Medical Specialties PLLC

🇺🇸

Tacoma, Washington, United States

Real e Benemerita Associacao Portuguesa de Beneficencia

🇧🇷

São Paulo, Brazil

307 Hospital of PLA

🇨🇳

Beijing, China

Kobe City Medical Center General Hospital

🇯🇵

Kobe-city, Japan

West China Hospital of Sichuan University

🇨🇳

Chengdu, China

Guangdong General Hospital

🇨🇳

Guangzhou, China

Local Institution - 600

🇨🇳

Guangzhou, China

The First Affiliated Hospital of Medical School of Zhejiang University

🇨🇳

Hangzhou City, China

Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine

🇨🇳

Shanghai, China

Charite - Universitaetsmedizin Berlin Campus Virchow Klinikum

🇩🇪

Berlin, Germany

Krankenhaus Nordwest

🇩🇪

Frankfurt, Germany

Fakultni nemocnice Kralovske Vinohrady, Interni hematologicka klinika

🇨🇿

Prague 10, Czechia

Klinkum der Stadt Villingen-Schwenningen GmbH

🇩🇪

Villingen-Schwenningen, Germany

Onkologische Schwerpunktpraxis Leer - Emden

🇩🇪

Leer, Germany

UZ Gent

🇧🇪

Gent, Belgium

Sun Yat-sen University Cancer Center

🇨🇳

Guangzhou, China

CHU d'Angers

🇫🇷

Angers, France

Peking Union Medical College Hospital

🇨🇳

Beijing, China

Local Institution - 534

🇨🇿

Praha, Czechia

Vseobecna Fakultni Nemocnice v Praze

🇨🇿

Praha, Czechia

MS INCA HC I Hospital do Cancer I

🇧🇷

Rio De Janeiro, Brazil

Sociedade Beneficente de Senhoras Hospital Sirio Libanes

🇧🇷

São Paulo, Brazil

Centre Hospitalier Universitaire d'Avicennes

🇫🇷

Bobigny Cedex, France

Soroka University Medical Center

🇮🇱

Beer Sheva, Israel

Hadassah University Hospital

🇮🇱

Jerusalem, Israel

The Third Xiangya hospital of central south university

🇨🇳

Changsha, China

CHRU de Brest - Hopital Morvan

🇫🇷

Brest Cedex, France

Jiangsu Province Hospital The First Hospital affiliated with Nanjing Medical University

🇨🇳

Nanjing, China

Peking University People's Hospital

🇨🇳

Beijing, China

CHU de Poitiers

🇫🇷

Poitiers, France

Charite - Universitaetsmedizin Berlin Charité - Campus Benjamin Franklin

🇩🇪

Berlin, Germany

Interni hematoonkologicka klinika

🇨🇿

Brno, Czechia

Kliniken Maria Hilf GmbH

🇩🇪

Mönchengladbach, Germany

Hopital Saint-Louis

🇫🇷

Paris, France

The First Affiliated Hospital of Soochow University

🇨🇳

Suzhou, China

Istituto Europeo di Oncologia - IEO

🇮🇹

Milano, Italy

Fakultni Nemocnice Ostrava, Klinika hematoonkologie,

🇨🇿

Ostrava, Czechia

Fakultni nemocnice Hradec Kralove, IV.interni hematologicka klinika

🇨🇿

Hradec Kralove, Czechia

MD Anderson Cancer Center

🇺🇸

Houston, Texas, United States

Eastbourne District General Hospital

🇬🇧

Eastbourne, United Kingdom

19 Mayis Medical Faculty - Samsun

🇹🇷

Samsun, Turkey

Mitchell Cancer Center, University of South Alabama

🇺🇸

Mobile, Alabama, United States

Arizona Center for Cancer Care

🇺🇸

Glendale, Arizona, United States

Southwest Cancer Care Medical Group

🇺🇸

Escondido, California, United States

Marin Oncology Associates

🇺🇸

Greenbrae, California, United States

Wilshire Oncology Medical Group, Inc

🇺🇸

La Verne, California, United States

North County Hematology Oncology (NCHO) - TRM, LLC.

🇺🇸

Oceanside, California, United States

Hematology-Oncology Medical Group of Orange County, Inc.

🇺🇸

Orange, California, United States

Central Coast Medical Oncology Corporation

🇺🇸

Santa Maria, California, United States

Cancer Center of Central Connecticut

🇺🇸

Southington, Connecticut, United States

Wellness Hematology Oncology

🇺🇸

West Hills, California, United States

Illinois Cancer Care, P.C.

🇺🇸

Peoria, Illinois, United States

Florida Cancer Specialists North Region Sarah Cannon Research

🇺🇸

Saint Petersburg, Florida, United States

LRG Healthcare Oncology Clinic

🇺🇸

Laconia, Indiana, United States

Iowa Oncology Research Association

🇺🇸

Des Moines, Iowa, United States

Providence Cancer Institute

🇺🇸

Southfield, Michigan, United States

University of Louisville, J.G. Brown Cancer Center

🇺🇸

Louisville, Kentucky, United States

Coborn Cancer Center at the St. Cloud Hospital

🇺🇸

Saint Cloud, Minnesota, United States

NH Oncology - Hematology, PA

🇺🇸

Hooksett, New Hampshire, United States

The Cancer Center at Hackensack University Medical Center

🇺🇸

Hackensack, New Jersey, United States

Hematology-Oncology Associates of Northern NJ

🇺🇸

Morristown, New Jersey, United States

University of New Mexico

🇺🇸

Albuquerque, New Mexico, United States

Weill Cornell Medical College

🇺🇸

New York, New York, United States

Ospedale degli Infermi di Rimini

🇮🇹

Rimini, Italy

Chugoku Central Hospital

🇯🇵

Hiroshima, Japan

National Cancer Center Hospital East

🇯🇵

Kashiwa, Japan

Local Institution - 513

🇵🇱

Warszawa, Poland

The Cancer Institute Hospital of Japanese Foundation For Cancer Research

🇯🇵

Koto-ku, Japan

University Hospital, Kyoto Prefectural University of Medicine

🇯🇵

Kyoto-city, Japan

Toranomon Hospital

🇯🇵

Minato-ku, Japan

National University Corporation Tohoku University, Tohoku University Hospital

🇯🇵

Sendai-shi, Japan

Instituto Portugues de Oncologia de Lisboa, Francisco Gentil

🇵🇹

Lisboa, Portugal

Local Institution - 330

🇵🇹

Lisboa, Portugal

Local Institution - 331

🇵🇹

Porto, Portugal

Hospital Auxilio Muto Centro de Cancer

🇵🇷

San Juan, Puerto Rico

Krasnoyarsk Regional Clinical Hospital

🇷🇺

Krasnoyarsk, Russian Federation

Russian Academy of Medical Sciences Institution

🇷🇺

Moscow, Russian Federation

St. Petersburg Pavlov State Medical University

🇷🇺

St.Petersburg, Russian Federation

Moscow State Medical Institution Municipal Clinical Hospital n.a. S.P. Botkin

🇷🇺

Moscow, Russian Federation

Federal Centre of Heart, Blood and Endocrinology of Rosmed technlologies V.A. Almazov

🇷🇺

St Petersburg, Russian Federation

The Ministry of Health and Social Development of the Tula region state institution Health Tula regio

🇷🇺

Tula, Russian Federation

Hospital de la Santa Creu i Sant Pau

🇪🇸

Barcelona, Spain

Hospital Universitario Reina Sofia

🇪🇸

Córdoba, Spain

Local Institution - 314

🇪🇸

Córdoba, Spain

Hospital Universitario Infanta Leonor

🇪🇸

Madrid, Spain

Hospital Universitario Fundacion Jimenez Diaz

🇪🇸

Madrid, Spain

Hospital Costa del Sol

🇪🇸

Marbella, Spain

Local Institution - 315

🇪🇸

Marbella, Spain

Cancer Hospital, Fudan University

🇨🇳

Shanghai, China

Hospital Morales Meseguer

🇪🇸

Murcia, Spain

Chinese Academy of Medical Sciences & Peking Union Medical College

🇨🇳

Tianjin, China

Tianjin Medical University Cancer Institute and Hospital

🇨🇳

Tianjin, China

Local Institution - 318

🇪🇸

Murcia, Spain

Local Institution - 311

🇪🇸

Salamanca, Spain

Cukurova University Medical Faculty Balcali Hospital

🇹🇷

Adana, Turkey

Hospital Universitario Virgen Del Rocio

🇪🇸

Sevilla, Spain

Hacettepe Universitesi

🇹🇷

Ankara, Turkey

Pamukkale University Medical Faculty

🇹🇷

Denizli, Turkey

Gaziantep University

🇹🇷

Gaziantep, Turkey

Kocaeli Derince Training and Research Hospital

🇹🇷

Umuttepe Kocaeli, Turkey

Marmara University

🇹🇷

Istanbul, Turkey

Dokuz Eylul University Izmir

🇹🇷

Izmir, Turkey

Royal Liverpool University Hospital, Prescot Street

🇬🇧

Liverpool, United Kingdom

Barts Cancer Institute, Queen Mary University of London, Charterhouse Square

🇬🇧

London, United Kingdom

Southend University Hospital NHS Foundation Trust, Prittlewell Chase

🇬🇧

Westcliff on Sea, United Kingdom

Hospital de Clínicas de Porto Alegre

🇧🇷

Porto Alegre, Rio Grande Do Sul, Brazil

Associacao Educudora Sao Carlos AESC Hospital Giovanni Battista HGB Hospital Mae de Deus Center

🇧🇷

Porto Alegre, Rio Grande Do Sul, Brazil

Associacao Hospitalar Moinhos de Vento Hospital Moinhos de Vento

🇧🇷

Porto Alegre, Rio Grande Do Sul, Brazil

Uniao Brasileira de Educacao e Assistencia Hospital Sao Lucas da PUCRS

🇧🇷

Porto Alegre, Rio Grande Do Sul, Brazil

Centro di Riferimento Oncologico - IRCCS

🇮🇹

Aviano (PN), Italy

U.O.C. Ematologia

🇮🇹

Barletta, Italy

A.O.U. di Bologna Policlinico S.Orsola-Malpighi

🇮🇹

Bologna, Italy

Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione Garibaldi - Nesima

🇮🇹

Catania, Italy

Istituto Scientifico Romagnolo Per Lo Studio e La Cura Dei Tumori (I.R.S.T.)

🇮🇹

Meldola, Italy

Ospedale Niguarda Ca Granda

🇮🇹

Milano, Italy

IRCCS- Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione "G. Pascale"

🇮🇹

Napoli, Italy

Az. Osp. Vincenzo Cervello

🇮🇹

Palermo, Italy

Casa di Cura La Maddalena

🇮🇹

Palermo, Italy

Azienda Ospedaliero-Universitaria di Parma

🇮🇹

Parma, Italy

Ospedale di Ravenna

🇮🇹

Ravenna, Italy

Azienda Ospedaliera Bianchi-Melacrino-Morelli

🇮🇹

Reggio Calabria, Italy

Azienda Ospedaliera S. Andrea - Università La Sapienza

🇮🇹

Roma, Italy

Fundacao Pio XII - Hospital de Cancer de Barretos

🇧🇷

Barretos, São Paulo, Brazil

AZ St-Jan Brugge Oostende AV

🇧🇪

Brugge, Belgium

Hospital Dr. Amaral Carvalho/ Hospital Amaral Carvalho Jaú

🇧🇷

Jau/SP, São Paulo, Brazil

St Francis Hospital

🇺🇸

Greenville, South Carolina, United States

Spartanburg Regional Healthcare System - Gibbs Cancer Center & Research Institute

🇺🇸

Spartanburg, South Carolina, United States

Malopolskie Centrum Medyczne S.C.

🇵🇱

Kraków, Poland

AZ Groeninge

🇧🇪

Kortrijk, Belgium

Tel-Aviv Sourasky Medical Center

🇮🇱

Tel-Aviv, Israel

CHU Mont -Godinne

🇧🇪

Yvoir, Belgium

Local Institution - 708

🇯🇵

Nagasaki-shi, Nagasaki, Japan

Local Institution - 709

🇯🇵

Minato-ku, Tokyo, Japan

National Cancer Center Hospital

🇯🇵

Chuo-ku, Japan

Nagoya Medical Center,Division of Hematology/Oncology

🇯🇵

Nagoya, Japan

Local Institution - 700

🇯🇵

Koto-ku, Japan

The Japanese Red Cross Nagasaki Genbaku Hospital

🇯🇵

Nagasaki, Japan

Instytut Hematologii i Transfuzjologii w Warszawie

🇵🇱

Warszawa, Poland

Local Institution - 514

🇵🇱

Warszawa, Poland

Centrum Onkologii, Instytut im. Marii Sklodowskiej-Curie

🇵🇱

Warszawa, Poland

Instituto Portugues de Oncologia do Porto, Francisco Gentil

🇵🇹

Porto, Portugal

Mayo Clinic

🇺🇸

Rochester, Minnesota, United States

Oncology Hematology Care Sarah Cannon Research

🇺🇸

Cincinnati, Ohio, United States

Local Institution - 028

🇺🇸

Portland, Oregon, United States

Providence Portland Medical Center

🇺🇸

Portland, Oregon, United States

Sarah Cannon Research Inst

🇺🇸

Nashville, Tennessee, United States

Hospital Universitario de Salamanca

🇪🇸

Salamanca, Spain

Local Institution - 340

🇮🇹

Roma, Italy

UC Davis Medical Center

🇺🇸

Sacramento, California, United States

Wake Forest Baptist Health

🇺🇸

Winston-Salem, North Carolina, United States

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